Individual
TARRAH DIVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2115 S FREMONT AVE, STE 4300, SPRINGFIELD, MO 65804-2239
(417) 820-3911
(417) 820-3924
Mailing address
2115 S FREMONT AVE, SUITE 4300, SPRINGFIELD, MO 65804
(417) 820-3911
(417) 820-3924
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2014003646
MO
Other
Enumeration date
02/06/2014
Last updated
08/10/2017
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